The tremendous escalation between 1990 and 2008 in international support for global health programs spawned a massive increase in medical and public health services throughout poor countries. In middle-income countries, especially Brazil, Russia, India, and China (the BRICs), the commensurate rise in chronic, noncommunicable diseases (NCDs), and continuing concerns over infectious scourges have coincided with this new era for global health. Combined, the largely infectious diseases–focused global health initiatives and rising demand for chronic disease and traumatic injuries management have placed a tremendous burden on health systems all over the world.

The surge in funding and interest, largely propelled by the expanding HIV pandemic, led to rapid proliferation of medical and public health programs, fragmentation and competition among them, and disorder. The explosion in both health initiatives and basic medical services occurred all over the world, but particularly in sub-Saharan Africa, Southeast Asia, and eastern Europe. As donor-financed programs expanded in those regions, most of Latin America and the BRICs made heavy domestic investments in their health systems, growing both the services they provided and public demand for both basic and secondary health care.

These extraordinary increases in provision and demand for health care sharpened focus on three bottom-line needs all of these countries - and many wealthy nations - share:

health financing schemes that cover the costs of care without putting health consumers, governments, or providers at risk of bankruptcy or severe economic hardship

systems of health-care delivery that can absorb the many now fragmented services and provide accessible treatment and prevention universally to those in need

a health-care workforce worldwide that should be at a minimum five million persons larger than it is currently, that displays a deeper range of skills, and that features greater attention to health management and community-based caregivers...